AB0502 PREVALENCE AND ASSOCIATED FACTORS FOR CONVENTIONAL DISEASE MODIFYING ANTI RHEUMATOID DRUG FAILURE IN PATIENTS WITH RHEUMATOID ARTHRITIS IN A TERTIARY CARE HOSPITAL IN SOUTHERN SRI LANKA
Authors: A. Ediriweera, S. Fernando, N. Dias, R. Hegodaarachchi, G. Udumalagala Gamage, A. Iranga, K. Deshapriya
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis. It is the most common form of chronic inflammatory arthritis and often results in joint damage and physical disability [1]. Among limited studies available in Sri Lanka the community prevalence of early rheumatoid arthritis is 0.7% [2]. Treatment should be aimed at reaching a target of sustained remission or Low Disease Activity (LDA) in every patient [3]. Achieving this target begins with convensional disease modyfying antirheumatic drugs (cDMARDS) and only limited number of biological DMARDS (bDMARD) is available in Sri Lanka. DMARD failure is a recognized problem in treating patients with rheumatoid arthritis. The poor response to cDMARDs once assessed in individual basis has variety of causes. The next step in managing patients with cDMARD failure is to offer bDMARDs. Biological DMARDs are expensive and give a major cost impact to the health budget especially during the background of economic crisis and the shortage of medicinal drugs. Knowing the prevalence of cDMARD failure is helpful in estimating costs for bDMARDs. <h3>Objectives:</h3> 1. To describe the prevalence of cDMARD failure among patients with RA attending the Department of rheumatology and rehabilitation- Teaching Hospital Karapitiya, Galle, sri Lanka 2. To determine the factors associated with cDMARDs failure 3. To describe the distribution of side effects of cDMARD <h3>Methods</h3> This study was carried out in 429 patients with RA attending a Department of Rheumatology &amp; Rehabilitation, Teaching Hospital Karapitiya, Southern Sri Lanka. Disease activity was measured by DAS28 of which moderate or high disease activity taken as a cDMARD failure sample and compared with non-failure sample (low disease activity/remission) to assess possible associated factors for poor response. <h3>Results</h3> Twenty-five point two out of 100 patients (25.2%) were found to have failed respond to cDMARDs, and females showed higher failure rate (17.2%) than males (4.2%). Except for 2.9% of those, all the others had been offered Methotrexate. Discontinuation of methotrexate due to side effects were observed in 5.7% in failure sample. Factors such as age, disease duration, education level, smoking had no significant impact on failure rate. <h3>Conclusion</h3> This study gives an insight to cDMARD failure prevalence which enables to predict the need of biologic DMARDs and impact on health budget. Furthermore, introduction of proper patient education program either individually or as groups would have account for minimum drug discontinuation which in turn helps with good response rate for cDMARDs. Introduction of injectable version of methotrexate could have helped in some intolerable side effects of methotrexate however, efficacy of this measure will depend on several factors such as cost, willingness of patients to self-inject etc. Finally, conventional DMARDS still play a significant role in the management of this debilitating disease with a comparatively low cost and an acceptable side effect profile. <h3>References</h3> [1]Ankoor Shah; E. William St. Clair. Rheumatoid Arthritis. Chapter 321. Harrison's Principles of Internal Medicine, 18th ed, McGraw Hill; New York, 2012: 2738-2750. [2]Inoshi Athukorala, et al. The community prevalence of early rheumatoid arthritis and health seeking behaviour of affected individuals. 20th World Congress of Epidemiology; August 2014. [3]Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update; Annals of the Rheumatic Diseases 2020;79:685-699. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.